This action might not be possible to undo. Are you sure you want to continue?
 It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli) and abnormal alveolar filling with fluid (consolidation and exudation). The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its cause may also be officially described as unknown when infectious causes have been excluded. Typical symptoms associated with pneumonia include cough, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics. Pneumonia is common occurring in all age groups, and is a leading cause of death among the young, the old, and the chronically ill. Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any complications, and the person's underlying health.
removed. (August 2009)
Pneumonias can be classified in several ways. The primary system of classification is the combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease or systemic disease, and whether the person has recently been hospitalized. Other classifications include according to the anatomic changes that can be found in the lungs during autopsies, based on the microbial cause, and a radiological classification.
Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. This is useful because chronic pneumonias tend to be either non-infectious, or mycobacterial, fungal, or mixed bacterial infections caused by airway obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as Streptococcus pneumoniae), the atypical pneumonias (such as the interstitial pneumonitis of Mycoplasma pneumoniae or Chlamydia pneumoniae), and the aspiration pneumonia syndromes. Chronic pneumonias, on the other hand, mainly include those of Nocardia, Actinomyces and Blastomyces dermatitidis, as well as the granulomatous pneumonias (Mycobacterium tuberculosis and atypical mycobacteria, Histoplasma capsulatum and Coccidioides immitis). The combined clinical classification, now the most commonly used classification scheme, attempts to identify a person's risk factors when he or she first comes to medical attention. The advantage of this classification scheme over previous systems is that it can help guide the selection of appropriate initial treatments even before the microbiologic cause of the pneumonia is known. There are two broad categories of pneumonia in this scheme: community-acquired pneumonia and hospital-acquired pneumonia. A recently introduced type of healthcare-associated pneumonia (in patients living outside the hospital who have recently been in close contact with the health care system) lies between these two categories.
CAP is the fourth most common cause of death in the United Kingdom and the sixth in the United States. • Bronchiolitis obliterans organizing pneumonia (BOOP) BOOP is caused by inflammation of the small airways of the lungs. a particular kind of white blood cell. • Eosinophilic pneumonia Eosinophilic pneumonia is invasion of the lung by eosinophils. the microorganisms a person is exposed to in a hospital are often different from those at home . microbiology. underlying heart and lung diseases. The most common causes of CAP vary depending on a person's age. including mechanical ventilation. Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonia. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia worldwide. also called nosocomial pneumonia. viruses. the atypical bacteria. it tends to be more deadly than community-acquired pneumonia. Hospital-acquired microorganisms may include resistant bacteria such as MRSA. Walking pneumonia is usually caused by the atypical bacterium. and immune disturbances. Because individuals with hospitalacquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria. It is also known as cryptogenic organizing pneumonitis (COP). SARS is caused by the SARS coronavirus. is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission. Hospital-acquired Main article: Hospital-acquired pneumonia Hospital-acquired pneumonia. CAP is the most common type of pneumonia. VAP is pneumonia which occurs after at least 48 hours of intubation and mechanical ventilation. and Haemophilus influenzae. Overall. treatment and prognosis are different from those of community-acquired pneumonia. and Serratia. . but they include Streptococcus pneumoniae.Community-acquired Main article: Community-acquired pneumonia Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not recently been hospitalized. Hospitalized patients may have many risk factors for pneumonia. Mycoplasma pneumoniae. Gram-negative bacteria cause CAP in certain at-risk populations. Pseudomonas. prolonged malnutrition. Additionally. Enterobacter. decreased amounts of stomach acid. The term "walking pneumonia" has been used to describe a type of community-acquired pneumonia of less severity (because the sufferer can continue to "walk" rather than require hospitalization). Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. The causes. a previously unknown pathogen. Other types • Severe acute respiratory syndrome (SARS) SARS is a highly contagious and deadly type of pneumonia which first occurred in 2002 after initial outbreaks in China. Eosinophilic pneumonia often occurs in response to infection with a parasite or after exposure to certain types of environmental factors.
Accordingly. vomiting. since they often cannot adequately protect their airways and may have otherwise impaired defenses. The resulting lung inflammation is not an infection but can contribute to one. Pneumocystis jiroveci. nausea. However. or after reflux or vomiting which results in bronchopneumonia. particularly during the Dust Bowl in the United States. invasive aspergillosis. either experienced during deep breaths or coughs or worsened by them. which may enter the body by inhalation or by skin contact. When the toxic substance is an oil. or phlegm and a high fever that may be accompanied by shaking chills.• Chemical pneumonia Chemical pneumonia (usually called chemical pneumonitis) is caused by chemical toxicants such as pesticides. blueness of the skin. especially by lay people. while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and . for instance. Klebsiella pneumoniae and Streptococcus pyogenes. With dust pneumonia. • Opportunistic pneumonia includes those that frequently strike immunocompromised victims. Other possible symptoms are loss of appetite. • Necrotizing pneumonia. Main pathogens are cytomegalovirus. • Double pneumonia is a historical term for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Less common forms of pneumonia can cause other symptoms. • Dust pneumonia Dust pneumonia describes disorders caused by excessive exposure to dust storms. experience headaches. Signs and symptoms Main symptoms of infectious pneumonia People with infectious pneumonia often have a cough producing greenish or yellow sputum. invasive candidiasis. Implicated bacteria are extremely commonly anaerobic bacteria. and joint pains or muscle aches. People with pneumonia may cough up blood. the term was. the term 'double pneumonia' is more likely to be used to describe bilateral pneumonia than it is ALI or ARDS. and sometimes even lung abscess. to denote pneumonia affecting both lungs. Type 3 pneumococcus is uncommonly implicated. Mycobacterium aviumintracellulare. although overlapping with many other classifications. and is used still. a sharp or stabbing pain. as well as the "usual bacteria" that strike immunocompetent people as well. the pneumonia may be called lipoid pneumonia. stopping the cilia from moving and preventing the lungs from ever clearing themselves. with or without additional facultatively anaerobic ones like Staphylococcus aureus. or develop sweaty and clammy skin. • Aspiration pneumonia Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating foreign objects which are usually oral or gastric contents. includes pneumonias that cause substantial necrosis of lung cells. mood swings. since the material aspirated may contain anaerobic bacteria or other unusual causes of pneumonia. either while eating. as is pleuritic chest pain. Shortness of breath is also common.. pneumonia caused by Legionella may cause abdominal pain and diarrhea. dust settles all the way into the alveoli of the lungs. Aspiration is a leading cause of death among hospital and nursing home patients. fatigue.
In elderly people. Typically. either when the virus directly kills the cells. even more lung damage occurs. Once in the lungs. (August 2009) Upper panel shows a normal lung under a microscope. or a low oxygen saturation. Pneumonia fills the lung's alveoli with fluid. Unsourced material may be challenged and removed. an increased respiratory rate. Although more than one hundred strains of microorganism can cause pneumonia. a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. The symptoms of infectious pneumonia are caused by the invasion of the lungs by microorganisms and by the immune system's response to the infection. Physical examination by a health care provider may reveal fever or sometimes low body temperature. Symptoms of pneumonia need immediate medical evaluation. People who are struggling to breathe. but increased rather than decreased vocal resonance (which distinguishes it from a pleural effusion). Infants with pneumonia may have many of the symptoms above. Less common causes of infectious pneumonia are fungi and parasites. infectious causes are the most common type. Percussion may be dulled over the affected lung. Viruses invade cells in order to reproduce. the virus invades the cells lining the airways and alveoli. Viruses Main article: Viral pneumonia Viruses have been found to account for between 18—28% of pneumonia in a few limited studies. low blood pressure. Pneumonia can be caused by microorganisms. This combination of cell . only a few are responsible for most cases. bronchial breathing on auscultation with a stethoscope (harsher sounds from the larger airways transmitted through the inflamed and consolidated lung).night sweats. They may develop a new or worsening confusion (delirium) or may experience unsteadiness. and rales (or crackles) heard over the affected area during inspiration. or through a type of cell controlled self-destruction called apoptosis. while the alveolus on the right is full of fluid from pneumonia. mainly lymphocytes. a high heart rate. but in many cases they are simply sleepy or have a decreased appetite. The most common causes of pneumonia are viruses and bacteria. activate certain chemical cytokines which allow fluid to leak into the alveoli. The alveolus on the left is normal. in studies it has been shown that two doctors can arrive at different findings on the same patient. keeping oxygen from reaching the bloodstream. White blood cells. Findings from physical examination of the lungs may be normal. The alveoli are filled with inflammation and debris. manifestations of pneumonia are seldom typical. they are insufficient to diagnose or rule out a pneumonia. While these signs are relevant. who are confused. which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. When the immune system responds to the viral infection. Cause This section needs additional citations for verification. moreover. but often show decreased expansion of the chest on the affected side. Please help improve this article by adding reliable references. When pneumonias are grouped this way. or who have cyanosis (blue-tinged skin) require immediate attention. leading to falls. irritants and unknown causes. The white spaces are alveoli that contain air. This invasion often leads to cell death. Lower panel shows a lung with pneumonia under a microscope.
Klebsiella pneumoniae. Bacteria are the most common cause of community acquired pneumonia with Streptococcus pneumoniae the most commonly isolated bacteria. bacteria may invade the spaces between cells and between alveoli through connecting pores. photographed through an electron microscope. and Coccidioides immitis. but can also reach the lung through the bloodstream when there is an infection in another part of the body. adenovirus. and also release cytokines. chills. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. The neutrophils. a type of defensive white blood cell. but it may occur in individuals with immune system problems due to AIDS. with Streptococcus agalactiae being an important cause of pneumonia in newborn babies. Another important Gram-positive cause of pneumonia is Staphylococcus aureus. Fungal pneumonia is most often caused by Histoplasma capsulatum. and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation. As well as damaging the lungs. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenzae. and parainfluenza. a common cause of pneumonia. Herpes simplex virus is a rare cause of pneumonia except in newborns. The neutrophils engulf and kill the offending organisms. People with weakened immune systems are also at risk of pneumonia caused by cytomegalovirus (CMV). and fatigue common in bacterial and fungal pneumonia. Pneumocystis jiroveci. for which reason bacterial pneumonia may complicate viral pneumonia. mouth and sinuses. bacteria. "Atypical" bacteria which cause pneumonia include Chlamydophila pneumoniae. Bacteria Main article: Bacterial pneumonia The bacterium Streptococcus pneumoniae. Pseudomonas aeruginosa and Moraxella catarrhalis. This leads to the fever. Many bacteria live in parts of the upper respiratory tract. Bacteria typically enter the lung when airborne droplets are inhaled. Gram-negative bacteria cause pneumonia less frequently than grampositive bacteria. to the lungs. This invasion triggers the immune system to send neutrophils. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. and can easily be inhaled into the alveoli. Fungi Main article: Fungal pneumonia Fungal pneumonia is uncommon. or other medical problems.destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. many viruses affect other organs and thus disrupt many body functions. causing a general activation of the immune system. Parasites Main article: Parasitic pneumonia . Escherichia coli. Viral pneumonia is commonly caused by viruses such as influenza virus. Cryptococcus neoformans. such as the nose. immunosuppresive drugs. respiratory syncytial virus (RSV). blastomyces. and Legionella pneumophila. and coccidioidomycosis in the southwestern United States. Once inside. Mycoplasma pneumoniae. Histoplasmosis is most common in the Mississippi River basin. Viruses can also make the body more susceptible to bacterial infections.
B: Abnormal chest x-ray with shadowing from pneumonia in the right lung (white area. Occasionally a chest CT scan or other tests may be needed to distinguish pneumonia from other illnesses. X-rays can be misleading. One type of white blood cell. indicating the presence of an infection or inflammation. Pneumonia is not always seen on x-rays. they travel to the lungs. like lung scarring and congestive heart failure. further investigations are needed to confirm the diagnosis. as in other cases of pneumonia. In some types of IIP. the eosinophil. However. Any bacteria identified are then tested to see which antibiotics will be most effective. Diagnosis Pneumonia as seen on chest x-ray. a combination of cellular destruction and immune response causes disruption of oxygen transportation. or if the health care provider has concerns about the diagnosis. some types of usual interstitial pneumonia. A complete blood count may show a high white blood cell count. usually through the blood. Sputum cultures generally take at least two to three days. the cause. The chest X-ray is typically used for diagnosis in hospitals and some clinics with X-ray facilities.A variety of parasites can affect the lungs. A blood sample may similarly be cultured to look for bacteria in the blood. Idiopathic Main article: Idiopathic interstitial pneumonia Idiopathic interstitial pneumonias (IIP) are a class of diffuse lung diseases.g. and the name is a misnomer. a culture of the person's sputum may be requested. and Ascariasis. Information from a chest X-ray and blood tests are helpful. A: Normal chest x-ray. in a community setting (general practice). e. thus complicating the underlying parasitic pneumonia.g. is unknown or idiopathic. especially those who have other illnesses. In some people with immune system problems. indeed. desquamative interstitial pneumonia is caused by smoking. so they are mainly used to confirm that the infection is sensitive to an antibiotic that has already been started. These parasites typically enter the body through the skin or by being swallowed. and sputum cultures in some cases. either because the disease is only in its initial stages.) If antibiotics fail to improve the patient's health. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Chest x-rays are also used to evaluate for complications of pneumonia (see below. In some types of IIP the cause of the pneumonia is known. or because it involves a part of the lung not easily seen by x-ray. responds vigorously to parasite infection. chest CT (computed tomography) can reveal pneumonia that is not seen on chest x-ray. Eosinophils in the lungs can lead to eosinophilic pneumonia. e. The most common parasites causing pneumonia are Toxoplasma gondii. can mimic pneumonia on x-ray. pneumonia is usually diagnosed based on symptoms and physical examination alone. Strongyloides stercoralis. left side of image). If pneumonia is suspected on the basis of a patient's symptoms and findings from physical examination. the white blood cell count . In some cases. because other problems. Once inside. Diagnosing pneumonia can be difficult in some people. There. CT of the chest demonstrating right sided pneumonia (left side of the image). Investigations An important test for pneumonia in unclear situations is a chest x-ray.
8 °C (100. Low blood sodium in pneumonia is thought to be due to extra anti-diuretic hormone produced when the lungs are diseased (SIADH). Specific blood serology tests for other bacteria (Mycoplasma. and adenovirus. due to its similar symptoms and signs. Respiratory secretions can also be tested for the presence of viruses such as influenza. Legionella and Chlamydophila) and a urine test for Legionella antigen are available.may appear deceptively normal. Combining findings One study created a prediction rule that found the five following signs best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room: • • • • • • • • • • • Fever > 37. Differential diagnosis Several diseases and/or conditions can present with similar clinical features to pneumonia. Appearance on X ray AP CXR showing left lower AP CXR showing lobe pneumonia associated with right lower lobe a small left sided pleural pneumonia effusion Normal AP CXR Normal lateral CXR . lung cancer and pulmonary emboli. Other diseases to be taken into consideration include bronchiectasis. similar to that of pneumonia. the one above and also were more accurate than physician judgment because of the increased specificity of the prediction rules. especially in the elderly. Blood tests may be used to evaluate kidney function (important when prescribing certain antibiotics) or to look for low blood sodium. Chronic obstructive pulmonary disease (COPD) or asthma can present with a polyphonic wheeze. respiratory syncytial virus.0 °F) Pulse > 100 beats/min Rales/crackles Decreased breath sounds Absence of asthma 5 findings – 84% to 91% probability 4 findings – 58% to 85% 3 findings – 35% to 51% 2 findings – 14% to 24% 1 findings – 5% to 9% 0 findings – 2% to 3% The probability of an infiltrate in two separate validations was based on the number of findings: A subsequent study comparing four prediction rules to physician judgment found that two rules. Liver function tests should be carried out to test for damage caused by sepsis. Pulmonary edema can be mistaken for pneumonia (and vice versa).
 A vaccine against Streptococcus pneumoniae is also available for adults. zanamivir. or azithromycin for community- . fluids. rimantadine. underlying health. Typically. with other medical problems.A lateral CXR showing AP CXR showing right lower lobe pneumonia of the pneumonia lingula of the left lung Right upper lobe pneumonia as marked by the circle. Bacterial Antibiotics improve outcomes in those with bacterial pneumonia. and location the infection was acquired. or those who do not have a spleen. The childhood pneumococcal vaccine is still as of 2009 predominantly used in high-income countries. health care workers. Treatment In the United States more than 80% of cases of community acquired pneumonia are treated without hospitalization. cerebrospinal fluid leaks. Rwanda became the first low-income country to introduce pneumococcal conjugate vaccine into their national immunization program. people who are having trouble breathing. Smoking cessation is important not only because it helps to limit lung damage. If the symptoms get worse.S. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced the role these bacteria play in causing pneumonia in children. though this is changing. In the UK empiric treatment is usually with amoxicillin. and the elderly may need greater care. alcoholism. In addition. In 2009. or complications occur. oral antibiotics. Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis. and then giving antibiotic treatment if needed. However. congestive heart failure. Hib vaccine is now widely used around the globe.. and pregnant women should receive the vaccine. Appropriately treating underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia. erythromycin. but also because cigarette smoke interferes with many of the body's natural defenses against pneumonia. Prevention There are several ways to prevent infectious pneumonia. the pneumonia does not improve with home treatment. cirrhosis of the liver. it is currently recommended for all healthy individuals older than 65 and any adults with emphysema. then hospitalized may be recommended. nursing home residents. and oseltamivir can help prevent influenza. When an influenza outbreak is occurring. diabetes mellitus. Suctioning the mouth and throat of infants with meconiumstained amniotic fluid decreases the rate of aspiration pneumonia. Initially antibiotic choice depends on the characteristics of the person affected such as age. Vaccinating children against Streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. Over the counter cough medicine has not been found to be helpful in pneumonia. Influenza vaccines should be given yearly to the same individuals who receive vaccination against Streptococcus pneumoniae. and home care are sufficient for complete resolution. reduces pneumonia in infants. medications such as amantadine. A repeat vaccination may also be required after five or ten years. Research shows that there are several ways to prevent pneumonia in newborn infants. rest. Vaccination is important for preventing pneumonia in both children and adults. In the U.
In other cases. the choice of antibiotic will depend on several factors. In North America. Antibiotics recommended for hospital-acquired pneumonia include third. which results from a combination of infection and inflammatory response. If infection is present in aspiration pneumonia. Pneumonia can also cause respiratory failure by triggering acute respiratory distress syndrome (ARDS). macrolides (such as azithromycin)." have shown resistance to rimantadine and amantadine. fluoroquinolones. where the "atypical" forms of community-acquired pneumonia are becoming more common. but there is no evidence to support their use either. These are beneficial only if they are started within 48 hours of the onset of symptoms. such as with a bi-level positive airway pressure machine. Chest x-ray showing a pleural effusion. The duration of treatment has traditionally been seven to ten days. Viral No specific treatments exist for most types of viral pneumonia including SARS coronavirus. Complications are more frequently associated with bacterial pneumonia than with viral pneumonia. Complications Sometimes pneumonia can lead to additional complications. This stiffness. or an aminoglycoside. often people with pneumonia have difficulty breathing. The most important complications include: Respiratory and circulatory failure Because pneumonia affects the lungs. The volume of useful lung is reduced . aminoglycosides. Many strains of H5N1 influenza A.and fourth-generation cephalosporins.acquired pneumonia. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns of side effects and resistance. and a ventilator may be used to help the person breathe. The lungs quickly fill with fluid and become very stiff. create a need for mechanical ventilation. Pleural effusion. and it may not be possible for them to breathe well enough to stay alive without support. hantavirus. and doxycycline have displaced amoxicillin as first-line outpatient treatment for community-acquired pneumonia. but there is increasing evidence that short courses (three to five days) are equivalent. and vancomycin. The A arrow indicates "fluid layering" in the right chest. Non-invasive breathing assistance may be helpful. Influenza A may be treated with rimantadine or amantadine while influenza A or B may be treated with oseltamivir or zanamivir. also known as avian influenza or "bird flu. Aspiration There is no evidence to support the use of antibiotics in chemical pneumonitis without bacterial superinfection. The B arrow indicates the width of the right lung. adenovirus. including the suspected causative organism and whether pneumonia was acquired in the community or developed in a hospital setting. These antibiotics are often given intravenously and may be used in combination. a combination of a beta-lactam antibiotic and metronidazole. and parainfluenza virus with the exception of influenza A and influenza B. Corticosteroids are commonly used in aspiration pneumonia. placement of an endotracheal tube (breathing tube) may be necessary. combined with severe difficulties extracting oxygen due to the alveolar fluid. carbapenems. Common options include clindamycin.
In severe cases of empyema. resulting in a reduction in lung volume and lung compliance. is associated with little mortality. and abscess Occasionally. and heart damage. bacteria in the lung will form a pocket of infected fluid called an abscess. Antibiotics are usually adequate to treat a lung abscess. Prognosis With treatment. about half of the people who develop methicillin-resistant Staphylococcus aureus (MRSA) pneumonia while on a ventilator will die. the fluid collection is called an empyema.because of the collection of fluid around the lung. Sepsis most often occurs with bacterial pneumonia. about one of every twenty people with pneumococcal pneumonia die. limited antibiotic choices. Sepsis and septic shock are potential complications of pneumonia. because antibiotics do not penetrate well into the pleural cavity. just over 20% of sufferers die. The eventual outcome of an episode of pneumonia depends on how ill the person is when he or she is first diagnosed. However. Sepsis occurs when microorganisms enter the bloodstream and the immune system responds by secreting cytokines. Sepsis can cause liver. The death rate (or mortality) also depends on the underlying cause of the pneumonia. They often require intravenous fluids and medications to help keep their blood pressure from dropping too low. Pneumonia caused by Mycoplasma. microorganisms infecting the lung will cause fluid (a pleural effusion) to build up in the space that surrounds the lung (the pleural cavity). the infection may persist. Rarely. In the United States. Limited access to clinics and hospitals. In regions of the world without advanced health care systems. Depending on the results of this examination.  . the fluid can often be collected with a needle (thoracentesis) and examined. When pleural fluid is present in a person with pneumonia. but sometimes the abscess must be drained by a surgeon or radiologist. Streptococcus pneumoniae is the most common cause. among other problems. the majority of deaths in children under five due to pneumococcal disease occur in developing coutries. If the microorganisms themselves are present in the pleural cavity. and mycoplasmal pneumonia may take four to six weeks to resolve completely. limited access to x-rays. Abscesses typically occur in aspiration pneumonia and often contain several types of bacteria. and inability to treat underlying conditions inevitably leads to higher rates of death from pneumonia. kidney. empyema. most types of bacterial pneumonia can be cleared within two to four weeks. a subacute inflammatory process in which the small airways are replaced by scar tissue. surgery may be needed. For these reasons. Viral pneumonia may last longer. Adenovirus can cause severe necrotizing pneumonia in which all or part of a lung has increased translucency radiographically. Severe adenovirus pneumonia also may result in bronchiolitis obliterans. Individuals with sepsis or septic shock need hospitalization in an intensive care unit. complete drainage of the fluid may be necessary. pneumonia is even deadlier. for instance. If the fluid is not drained. and it often causes death. Lung abscesses can usually be seen with a chest x-ray or chest CT scan. often requiring a chest tube. In cases where the pneumonia progresses to blood poisoning (bacteremia). which is called Swyer-James Syndrome. Pleural effusion.
6 million people a year making it the 6th leading cause of death. and more often in Blacks than Caucasians due to differences in synthesizing Vitamin D from sunlight. many of these deaths occur in the newborn period. cystic fibrosis. These rules can be helpful in deciding whether or not to hospitalize the person. Pneumonia occurs more commonly in males than females. • Pneumonia severity index (or PORT Score) – online calculator • CURB-65 score. .. In the United States community acquired pneumonia affects 5. the ancient Greek physician known as the "father of medicine" WPA poster. Individuals with underlying illnesses such as Alzheimer's disease. More cases of pneumonia occur during the winter months than during other times of the year. and if sweats come out about the neck and head. or having any other character different from the common. which takes into account the severity of symptoms. rales. alcoholism. These individuals are also more likely to have repeated episodes of pneumonia. and the violence of the disease which is obtaining the upper hand. For those over 75 years of age. and it is bad if he has dyspnoea. and the sputa expectorated be of a blond or livid color. or immune system problems are at increased risk for pneumonia. or in both. Roughly 20–40% of individuals who contract pneumonia require hospital admission of which between 5–10% are admitted to a critical care unit. In the United Kingdom. as proceeding from the suffocation. It is a major cause of death among all age groups and is the leading cause of death in children in low income countries. The World Health Organization estimates that one in three newborn infant deaths are due to pneumonia. The mortality rate in the UK is around 5–10%. 1936/1937 The symptoms of pneumonia were described by Hippocrates (c. and florid. are to be thus observed: If the fever be acute.Clinical prediction rules Clinical prediction rules have been developed to more objectively prognosticate outcomes in pneumonia. any underlying diseases. In children. frothy. this rises to 75 cases for every 1000 people. Mortality from pneumonia generally decreases with age until late adulthood with increased mortality in the elderly. History Hippocrates. tobacco smoking. the annual incidence of pneumonia is approximately 6 cases for every 1000 people for the 18–39 age group. and urine that is thin and acrid. and pleuritic affections. and over 90% of these deaths take place in developing countries. Over two million children under five die each year worldwide and it is estimated that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria Streptococcus pneumoniae. 460 BC – 370 BC): Peripneumonia. or likewise thin. for such sweats are bad.. and age – online calculator Epidemiology Pneumonia is a common illness in all parts of the world. and if there be pains on either side. the case is beyond remedy if he is not purged. People who are hospitalized for any reason are also at high risk for pneumonia. emphysema. When pneumonia is at its height. and if expiration be if cough be present.
the global health community has declared November 2 to be World Pneumonia Day. which is a chronic disease characterized by elevation of blood pressure. and it reflected the extent of medical knowledge through the Middle Ages into the 19th century. known as "the father of modern medicine.However. Hippocrates referred to pneumonia as a disease "named by the ancients." He also reported the results of surgical drainage of empyemas. several key developments in the 1900s improved the outcome for those with pneumonia. search A diagram explaining factors affecting arterial pressure The pathophysiology of hypertension is an area of active research. Christian Gram's paper describing the procedure in 1884 helped differentiate the two different bacteria and showed that pneumonia could be caused by more than one microorganism. modern surgical techniques. attempting to explain causes of hypertension. or tuberculosis. and intensive care in the twentieth century. the free encyclopedia Jump to: navigation. Friedländer's initial work introduced the Gram stain.) However. Sir William Osler. Hypertension . sticking [pleuritic] pain in the side. Maimonides (1138–1204 AD) observed "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever. (The phrase was originally coined by John Bunyan with regard to consumption. Vaccination against Streptococcus pneumoniae in adults began in 1977 and in children began in 2000. With the advent of penicillin and other antibiotics. a fundamental laboratory test still used to identify and categorize bacteria. respectively. a day for concerned citizens and policy makers to take action against the disease. serrated pulse and cough. Pathophysiology of hypertension From Wikipedia. Vaccination of infants against Haemophilus influenzae type b began in 1988 and led to a dramatic decline in cases shortly thereafter. Bacteria were first seen in the airways of individuals who died from pneumonia by Edwin Klebs in 1875." appreciated the morbidity and mortality of pneumonia. short rapid breaths. Society and culture Because of the very high burden of disease in developing countries and because of a relatively low awareness of the disease in industrialized countries." This clinical description is quite similar to those found in modern textbooks. resulting in a similar decline. as it had overtaken tuberculosis as one of the leading causes of death in his time. describing it as the "captain of the men of death" in 1918. mortality from pneumonia dropped precipitously in the developed world. Initial work identifying the two common bacterial causes Streptococcus pneumoniae and Klebsiella pneumoniae was performed by Carl Friedländer and Albert Fränkel in 1882 and 1884.
and is a leading cause of chronic renal failure. heart attacks. Secondary hypertension indicates that the high blood pressure is a result of another underlying condition.can be classified as either essential or secondary. Cardiac output is determined by stroke volume and heart rate. stroke volume is related to myocardial contractility and to the size of the vascular compartment. heart failure and arterial aneurysm. Persistent hypertension is one of the risk factors for strokes. Most mechanisms leading to secondary hypertension are well understood. Peripheral resistance is determined by functional and anatomic changes in small arteries and arterioles. The pathophysiology of essential hypertension remains an area of active research. with many theories and different links to many risk factors. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Contents [hide] . such as kidney disease or tumours (adrenal adenoma or pheochromocytoma). Cardiac output and peripheral resistance are the two determinants of arterial pressure. About 90-95% of hypertension is essential hypertension.